Comparing Conservative and Surgical Treatment of Acute Nondisplaced Fractures of the Scaphoid Based on Fracture Location: A Systematic Review and Meta-Analysis

INTRODUCTION: Treatment of nondisplaced scaphoid fractures with either nonsurgical or surgical methods ideally involves shared decision making. To date, no meta-analysis has explicitly reported differences in healing rates between fracture locations and treatment choices, making this conversation challenging. We aimed to report the nonunion risk in nondisplaced scaphoid fractures when stratified by both treatment type and fracture location. METHODS: We searched PubMed, SCOPUS, CINAHL, SportsDiscus, HAND, Journal of Hand Surgery, and Plastic and Reconstructive Surgery for outcome studies of nonsurgical or surgical treatment of acute, nondisplaced scaphoid fractures. Meta-analyses were conducted for the pooled proportion of fracture nonunion of each fracture location and treatment modality. RESULTS: We screened 2019 articles, and 29 were included in the final data analysis. The pooled proportion of scaphoid fracture nonunions was higher among those treated nonsurgically than surgically, although prediction intervals were overlapping and significance was not established. We found that, regardless of the treatment method, proximal fragment fractures have the highest rate of nonunion. When evaluating only proximal scaphoid fractures, the proportions of nonunion were similar between nonsurgical and surgical subgroups. DISCUSSIONS: Our review indicates that surgical treatment results in overall fewer nonunions than nonsurgical treatment, but with overlapping prediction intervals. However, when analyzing subgroups, we found that this association is less clear for proximal scaphoid fractures. Our review highlights a distinct lack of literature on scaphoid fractures of the distal pole. CONCLUSIONS: The results of this study can be used to inform shared decision making when discussing treatment for a nondisplaced scaphoid fracture.